General Surgery Coding Alert

Question: If our surgeon sees a patient, and later that same day, another physician admits the patient to the hospital, should our surgeon report an inpatient or outpatient E/M code?

Answer: If you know at the time you bill for your surgeon's service that the patient was admitted to inpatient status on the same date, you should use the inpatient codes for one simple reason -- they pay better. Coding rules state, however, that you can choose to code an inpatient or outpatient E/M service on the admission date, so either choice would be correct.

Watch for payer restrictions: There are some payers who will always deny an outpatient E/M on the date of an admission so it is worth making note of which payers are giving you this kind of problem and try to code in such a way that you can avoid the denial and the expensive appeal.

Be ready to appeal: Sometimes you just don't know at billing time that a patient has been admitted. Do your best to be as accurate as possible, and understand that there will be some claims you will have to appeal after the denial comes in.